Hematospermia: Causes and evaluation (A local study)

Abstract

Objectives: To assess the possible causes of hematospermia.Patients and methods: From October 2013 to October 2019, 169 patients presenting with hematospermia in Al Ramadi teaching hospital and private urologist clinic were included in this observational prospective study. The patients were divided into 2 groups according to the age; group A for those who are younger than 40 years and group B for those who are 40 years and older. Complete physical examination and digital rectal examination (DRE) done for every patient, all patients were evaluated by urinalysis, urine culture, complete blood count, serum uric acid measurement, abdominal and /or transrectal ultrasonography, prostatic specific antigen (PSA) and seminal fluid analysis, in addition to urine cytology, polymerase chain reaction (PCR) for urinary tuberculosis, excretory urography, CT scan, MRI, prostatic biopsy and cystoscopy in selected cases.Result:The mean age of patient was 55+10.5 sd ranging from 25 to 75 years. The identified causes in group A are sexually transmitted diseases in 30 patients, prostatitis in 17 patients, sever hypertension in 10 cases, hyperuricemia in 5 cases, vigorous sexual intercourse in 5 cases, prostatic calculi in 5 case, seminal vesicle calculi in 2 cases, bleeding tendency in one case, urinary tuberculosis in one case and no identifiable causes in the remaining 13 patients. The identified causes in group B are benign prostatic hyperplasia in 32 cases, sever hypertension in 15 cases, active urinary tract infection in 8 cases, prostatic calculi in 6 cases, prostatic cancer in 4 cases, bleeding tendency in 3 cases and no identifiable causes in the remaining 13.Conclusion: The causes of hematospermia are mostly benign as occurrence of serious pathology was rare but patients with alarming features as older age, persistent hematospermia or recurrent hematospermia should have thorough assessment to identify curable diseases and to rule out malignancy.